The goals of this project are to continue and to strengthen our pre- doctoral and post-doctoral training in health services research. The original grant proposal emphasized the importance of multidisciplinary training for health services research and the fact that multiple opportunities for such training are available at the University of Rochester. The programs at the UR have developed based on these resources. The training program which has evolved is predicated on the belief that there is a critical need in academia, government, and the private sectors for new researchers with multidisciplinary training. Such roles demand backgrounds in statistics, economics, and public policy analysis combined with an understanding of the institutions, structure, and functioning of the U.S. health care system and with health services research methods. This training is provided to students in the doctoral program through three different "tracks": general health services research/clinical evaluative sciences, public policy, and economics. For persons trained in medicine, the post-doctoral program emphasizes the acquisition of research skills to produce competence in health services research, e.g. statistics, epidemiology, and clinical decision theory. For post-doctoral students with doctoral training in the social sciences, the program emphasizes the unique features of the U.S. health care system and the specialized methods of health services research. The departments collaborating in this program are all nationally prominent and provide excellent training to program fellows. The proposed training program responds specifically to five areas of interest to AHCPR, including (1) cost effectiveness and cost benefit analysis including the allocation of health care resources and its relationship to health status, (2) appropriateness and effectiveness including cost-effectiveness of alternative treatments and technologies, (3) primary care issues including the relationship between the structure and organization of service delivery and access to and cost and outcomes of care, (4) the evaluation of managed care and other alternative approaches to organizing, financing, and reimbursing health care services, and (5) alternative delivery systems, providers, and practice patterns in long-term care including home and community-based care.